To Meet HIV World Health Goals,
TB Must Also Be Reduced

Statement from FIRS (Forum of International Respiratory Societies) for World AIDS Day – 1 December 2019

The World Health Organization (WHO) has set a goal of ending the AIDS epidemic by 2030. To achieve that goal, the Forum of International Respiratory Societies (FIRS), of which Asian Pacific Society of Respirology is a founding member, is calling on governments, health advocates and non-government organisations on World AIDS Day to strengthen their response to AIDS and tuberculosis (TB).

TB is the leading cause of death among those with HIV/AIDS worldwide, accounting for about one in three deaths, according to the 2019 UNAIDS Global update.

"People with latent TB who are HIV positive need TB preventative therapy," said James Beck, MD, ATSF, president of the American Thoracic Society, a FIRS founding member. "Studies show that this preventative therapy can reduce the chances of dying from TB and AIDS by around 40 percent."

In the developing world, TB is often the first sign a person has HIV. Yet, about half of the people living with HIV and tuberculosis are unaware of their co-infection and therefore not receiving care that could prevent serious illness and death, according to WHO.

Shortly after AIDS emerged, it fuelled a global resurgence of TB that continues in many low- and middle-income countries. According to the Centers for Disease Control and Prevention, HIV infection is the strongest risk factor for progressing from latent to active TB.

HIV increases the risk of other infectious respiratory diseases, including pneumocystis jiroveci pneumonia (PCP) and bacterial pneumonia, both of which can be life threatening.

Since the AIDS epidemic began, the WHO estimates that about 75 million people have become infected with HIV and 32 million people have died from AIDS-related illnesses. Today, in Africa alone more than 25 million people are living with HIV.

Education, prevention strategies and new medicines, particularly antiretroviral therapies, have reduced the number of AIDS deaths each year by more than half since their peak globally in 2004.

Still, UNAIDS estimates that in 2018 nearly 40 million people were living with AIDS and about 1.7 million people became newly infected.

FIRS believes a global response to HIV/AIDS can be strengthened by:

• Increasing awareness of the continuing global threat of HIV-related disease and its link to TB and other respiratory diseases.
• Improving the health outcome of people living with HIV through patient care and research into improved treatments and treatment strategies for both HIV and TB.
• Reducing the incidence and severity of HIV-related disease by strengthening mother-to-child transmission prevention programmes and increasing the early use of antiretroviral therapy.
• Improving HIV education in at-risk communities to reduce the incidence of new HIV infections.
• Reducing HIV-related health disparities and inequities.

"The good news is that antiretroviral therapies have turned HIV/AIDS from a death sentence into a chronic disease, and TB is preventable and curable," Dr. Beck said. "These two facts, along with the millions of lives that we can save, should strengthen our resolve to make sure these medical advances are available to everyone."

World AIDS Day Fact Sheet 2019
AIDS: Progress, but Still a Major Global Killer

• In 2018, AIDS deaths were down more than half from 2004, when they peaked worldwide. However, the World Health Organization (WHO) still estimates that 770,000 people died from AIDS last year.
• According to the WHO, 37.9 million people were living with HIV and 1.7 million became newly infected in 2018. Approximately 8.1 million do not know they are HIV-positive.
• Around the globe, women make up 52 percent of those living with HIV, and in 2018, new infections among young women (aged 15–24 years) were 55 percent higher than among men of the same age, according to the Foundation for AIDS Research (amfAR).
• More than half of new HIV infections globally in 2018 were among key populations (men who have sex with men, people who inject drugs, sex workers, and transgender people) and their sexual partners, amfAR reports.
• Africa is the region of the world hardest hit by AIDS: 25.6 million Africans, not including those living in North Africa, are living with HIV. Young women are particularly affected. In sub-Saharan Africa, women aged 15-24 are twice as likely as men to be living with HIV, the WHO reports.
• HIV/AIDS is a problem around the world: 5.9 million people are living with HIV in Asia and the Pacific, 2.2 million in Western and Central Europe and North America, 1.9 million in Latin America, 340,000 in the Caribbean, and 240,000 in the Middle East and North Africa, the WHO estimates.
• Worldwide, 62 percent of those living with HIV are accessing antiretroviral therapy. Among pregnant women, 82 percent are accessing antiretroviral medicines to prevent transmission of HIV to their child, according to the WHO.
• In the United States, African Americans and Hispanics account for a disproportionate share of HIV diagnoses, 43 percent and 26 percent respectively in 2017, according to the Centers for Disease Control and Prevention.
• The CDC estimates that 51 percent of young people (aged 13-24) who are HIV-positive in the U.S. do not know they are infected.

AIDS, TB and Other Respiratory Diseases

• People with HIV are at increased risk of respiratory disease, including tuberculosis.
• TB is the leading cause of death among people living with HIV, accounting for around one in three AIDS-related deaths worldwide, according to the WHO.
• The WHO reports that about half of those living with HIV and TB are unaware of their coinfection and therefore are not receiving care, which can reduce their chances of dying by around 40 percent.
• Shortly after it emerged, HIV/AIDS fuelled a global resurgence of TB that continues in many low- and middle-income countries. According to the CDC, HIV infection is the strongest risk factor for progressing from latent to active TB.
• Other infectious respiratory diseases are common in those with HIV, including pneumocystis jiroveci pneumonia (PCP) and bacterial pneumonia, both of which can be life threatening. Where antiretroviral therapy is widely available, noninfectious pulmonary diseases, such as COPD, pulmonary arterial hypertension, and lung cancer are often the cause of death in people with HIV.
• In the U.S., people with HIV are two to three times as likely to smoke as those who are HIV-negative, according to the CDC. Smoking compounds the challenges of treating infectious and non-infectious respiratory diseases in those with HIV.

The FIRS Response

The Forum of International Respiratory Societies (FIRS) calls on governments, health care programmes, clinicians, public health specialists, and non-government organizations to strengthen their responses to HIV/AIDS by:

• Increasing awareness of the continuing global threat of HIV-related disease and its connection to TB and other respiratory diseases.
• Improving HIV education of at-risk communities to reduce the incidence of new HIV infections and decrease health disparities.
• Reducing the incidence and severity of HIV-related disease by strengthening mother-to-child transmission prevention programmes and increasing the early use of antiretroviral therapy.
• Ending HIV-associated TB through TB infection control, preventive therapy, and widespread use of antiretroviral therapy.
• Adequately funding research into improved treatments for both HIV and TB.

About the Forum of International Respiratory Societies

The Forum of International Respiratory Societies (FIRS) is an organization comprising the world's leading international respiratory societies working together to improve lung health globally: American College of Chest Physicians (CHEST), American Thoracic Society (ATS), Asian Pacific Society of Respirology (APSR), Asociación Latino Americana de Tórax (ALAT), European Respiratory Society (ERS), Global Initiative for Asthma (GINA), Global Initiative for Chronic Obstructive Lung Disease (GOLD), International Union Against Tuberculosis and Lung Diseases (The Union), and the Pan African Thoracic Society (PATS).

The goal of FIRS is to unify and enhance efforts to improve lung health through the combined work of its more than 70,000 members globally.

Contact: Lisa Roscoe, lisa.roscoe@firsnet.org